Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 55547 | TX |
NPI | 1003190612 |
---|---|
Provider Name | Mr. Ashley Shaquelle Mitchell |
First Address | Houston, TX 77030-4211 |
Second Address | Houston, TX 77030-4211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2011 |
Last Update Date | 30/09/2011 |